Is Cervical (neck) Fusion Surgery Considered a Radical Solution?

Is Cervical (neck) Fusion Surgery Considered a Radical Solution?

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Hi, my name is Dr. John Shim, and I want to discuss anterior cervical discectomy and fusion surgery. At this point, you have already failed non-surgical treatments and have decided to move forward with the operation. When we reviewed your diagnostic studies, the main reason this surgery is offered is secondary to disc herniation, or bone spurs that cause entrapment of the nerves, and cause associated nerve pain, numbness or weakness. Let me show you a typical cervical MRI of a disc herniation. This is a sagittal view. It shows the neck from the side. For most patients, there are some normal disc levels identified, but the offending disc shows a mask pushing backwards onto the spinal canal and nerves or spinal cord. On this axial view, or cross-sectional view, you can see the disc material coming out of the outer layers of the disc, or the annulus, and causing pressure on the thecal sac, the spinal nerves and the spinal cord. For most patients, this will cause radiating pain and numbness in a specific pattern. These numbness and sensation patterns are called dermatomes. There are often associated with reflex and muscle strength findings. For some patients, there is more than one disc level of involvement. Surgery is performed through an incision on the front of the neck. Care is taken to dissect safely through the interval between various muscle groups. Care is taken to protect the windpipe, the food pipe and the arteries and veins. Once the bones of the front of the neck are exposed, the disc herniation is removed from the disc space, taking pressure off the thecal sac, the individual nerves and/or the spinal cord. Compressing bone spurs can also be removed. The bone edges are scraped clear of all soft tissue, and contoured appropriately to accept the bone graft or cage. Once measured, the appropriate size graph is placed in the disk space. Some patients will have more than one disk removed during the operation. Plates and screws are used to secure the bone graft in the disc space, and provide stability while the bone grows into the graph. Once fused, the plates and screws are not necessary, but it is rare to remove the plates and screws unless there is an issue. The incision is closed depending on the circumstance a cervical collar may be recommended. Depending on the circumstance, your surgeon may restrict certain activities for a certain time. The operation has a high success rate, and most patients will be able to return back to the activities after several months. This is the basic animation of the operation. You should discuss your individual concerns with your surgeon this is Dr. John Shim, and I hope this video was helpful for your understanding of the anterior cervical discectomy and fusion operation. Thank you! you

Many people are both upset and frightened when their spine surgeon recommends a fusion as a solution to their neck problems. An anterior cervical discectomy and fusion (ACDF), in the properly selected patient, has a very high success rate, with very satisfied patients.
In our practice, patients who elect to have cervical fusion typically have these following criteria:

  1. Usually, the patients have neck pain with arm radiculopathies (pain, numbness or tingling down the arms and into the hands). Often just on one side in the case of a disc herniation.
  2. Diagnostic studies usually reveal one or more cervical disk herniations, cervical bones spurs (spinal stenosis), or evidence of instability of the cervical spine.  Those are the most common indications for cervical fusions.  Less often, but still common, the studies can reveal a fracture, infection or tumor.  In that scenario, often surgery needs to be performed on an urgent basis.  If you have any of the last three problems, you should have evaluation immediately, so as to avoid a potential permanent problem.
  3. If you have progressive weakness, or increasing pain despite non-surgical care, then you are a candidate.  In some instances, the location of the disk herniation or bone spur may be accessible by a posterior neck decompression surgery called a foraminotomy.  In this situation, you can remove the cause of the neck pain and arm pain without fusion.  Your surgeon will be able to discuss why you would or would not be a candidate for this lesser surgical option.  In general, if the location of the disk herniation or bone spur is more towards the midline of the spine, it can be risky to move the spinal cord to remove the spur with the lesser foraminotomy procedure.
  4. One and two level cervical fusions have a better predicted outcome than three or more levels.  If you need more than two levels, please discuss the rationale for the multiple levels.  In my practice, we try to avoid more than two levels, but, in certain instances such as multiple levels of disk herniations or spurs, you cannot avoid the additional levels of surgery.
  5. Patients are counseled not to smoke.  Any type of fusion surgery has a higher success rate in patients who do not smoke.  Smoking is associated with higher rates of non-union, or failure of the bones to successfully unit.

Cervical fusions are very successful in the properly selected patient, and have a much higher satisfaction and outcome than lower back fusion surgery.  Please do not assume neck fusion surgery and lower back fusion surgery have the same results.  If you have significant neck pain, with corresponding nerve compression pain limited to one or two levels, cervical fusion can be a good treatment option for you.

Citations

  • Gutman G, Rosenzweig DH, Golan JD. The Surgical Treatment of Cervical Radiculopathy: Meta-analysis of Randomized Controlled Trials. Spine (Phila Pa 1976). 2017 Jul 11; PubMed PMID: 28700452
  • Wu TK, Wang BY, Meng Y, Ding C, Yang Y, Lou JG, Liu H. Multilevel cervical disc replacement versus multilevel anterior discectomy and fusion: A meta-analysis. Medicine (Baltimore). 2017 Apr;96(16):e6503. PubMed PMID: 28422837

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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